The healthcare needs of rural communities are not being properly met, says a report by the British Medical Association.

It highlights a lack of public transport and too much centralisation of services.

Dr Eugene Deeny is a GP in Belleek, a small village in County Fermanagh in Northern Ireland.

He is one of three GPs serving 4,000 patients in a practice area which is 18 miles wide and 10 miles long.

Some of our patients are very much dependent on family or neighbours to run them in to the surgery.

Dr Eugene Deeny

Dr Deeny said many health care policies had been developed to serve people who lived in towns - and often did not work for people in rural areas.

He said the biggest problem for his patients was the fact that they could not easily access health care services.

Dr Deeny said that not only was it difficult for some patients living miles from the practice to get to their GP, they then also had problems getting to the hospital which is 25 miles in Enniskillen if they needed follow up care.

And he said patients who needed specialist cardiac or cancer services could face a 230-mile round trip to Belfast.

The problem was compounded by the fact that many of the most needy patients were elderly.

However, some young families also had problems, as often they only had one car, and that had to be used to work.

"Public transport is even less accessible to people now than it was years ago," said Dr Deeny.

"We have very poor roads between the rural areas and our main hospitals, and taxi services are few and fair between, and expensive.

"Some of our patients are very much dependent on family or neighbours to run them in to the surgery.

"And because the A&E unit at Enniskillen is so far away we tend to see a lot more injuries as patients turn up to the surgery, rather than the hospital."

The difficulty of accessing health services also meant that some people put off consulting a doctor longer than was advisable, said Dr Deeny.

Specialist clinics needed

Dr Deeny said the local surgeries were very good, as was the district nursing service.

It is very rewarding.

Dr Eugene Deeny

But he said there was difficulty in recruiting and retaining GPs in rural areas.

Not only was there a perception that working in rural areas left doctors professionally isolated, there were logistical problems such as finding work for partners, and schools for children.

In addition medical schools did little to promote rural practice as a positive option, he said.

Dr Deeny said there was also a pressing need to develop more specialist services, such as chiropody, physiotherapy and dentistry.

This could be done by establishing consultant outreach clinics at local surgeries, he said.

He also called for better use of modern technology, such as video counselling.

"This would allow patients to be seen in doctor's surgeries, but consult a specialist at a local hospital at the same time."

But, despite the problems of being a rural doctor, Dr Deeny said he did not regret practising in an isolated area.

"You have to make sacrifices. For instance, you have to be prepared to travel for shopping, leisure and entertainment," he said.